Provider Demographics
NPI:1063846871
Name:SIMS, JESSICA WHITE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:WHITE
Last Name:SIMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10867 BRENTWAY CV
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-9620
Mailing Address - Country:US
Mailing Address - Phone:662-501-0924
Mailing Address - Fax:
Practice Address - Street 1:4028 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1325
Practice Address - Country:US
Practice Address - Phone:662-393-3477
Practice Address - Fax:662-393-3214
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-13011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist